Optimal timing for hemodialysis in relation to hip fracture surgery for patients with end-stage renal disease

End-stage renal disease (ESRD) is associated with a significantly increased risk of hip fractures and a higher rate of postoperative complications and mortality, particularly in patients on hemodialysis (HD). The timing of HD relative to surgery may influence outcomes by altering acid–base balance, electrolyte levels, and fluid status. This study aimed to evaluate the effect of perioperative HD timing on postoperative complication rates in ESRD patients undergoing hip fracture surgery. This retrospective cohort study included patients with ESRD on HD who underwent operative treatment for hip fractures at a single Level I academic trauma center. Patient demographics, comorbidities, and perioperative variables were collected. Timing of HD was calculated as the interval in hours from the start of HD to the start of surgery. Disruptions in patients’ routine HD schedules were also recorded. Univariable logistic regression was used to assess associations between HD timing and 90-day postoperative complications. Forty-one patients met inclusion criteria; 25 (61.0%) experienced a postoperative complication. The interval between HD and surgery did not significantly predict postoperative outcomes. Disruption of routine HD schedules, observed in 31 patients, was also not associated with increased risk of complications (OR = 0.94, 95% CI = [0.22, 4.00], p = 0.929). Neither the timing of preoperative HD nor disruptions in HD scheduling were significantly associated with 90-day postoperative complications in ESRD patients undergoing hip fracture surgery. As the first study to examine this relationship in this population, these findings contribute to the growing body of evidence guiding perioperative management in dialysis-dependent patients. Further research with larger sample sizes is needed to confirm these results.